Surgical Risk Preoperative Assessment System (SURPAS): III. Accurate Preoperative Prediction of 8 Adverse Outcomes Using 8 Predictor Variables.
Ann Surg
; 264(1): 23-31, 2016 07.
Article
em En
| MEDLINE
| ID: mdl-26928465
OBJECTIVE: To develop accurate preoperative risk prediction models for multiple adverse postoperative outcomes applicable to a broad surgical population using a parsimonious common set of risk variables and outcomes. SUMMARY BACKGROUND DATA: Currently, preoperative assessment of surgical risk is largely based on subjective clinician experience. We propose a paradigm shift from the current postoperative risk adjustment for cross-hospital comparison to patient-centered quantitative risk assessment during the preoperative evaluation. METHODS: We identify the most common and important predictor variables of postoperative mortality, overall morbidity, and 6 complication clusters from previously published prediction analyses that used forward selection stepwise logistic regression. We then refit the prediction models using only the 8 most common and important predictor variables, and compare the discrimination and calibration of these models to the original full-variable models using the c-index, Hosmer-Lemeshow analysis, and Brier scores. RESULTS: Accurate risk models for 30-day outcomes of mortality, overall morbidity, and 6 clusters of complications were developed using a set of 8 preoperative risk variables. C-indexes of the 8 variable models are between 97.9% and 99.2% of those of the full models containing up to 28 variables, indicating excellent discrimination using fewer predictor variables. Hosmer-Lemeshow analyses showed observed to expected event rates to be nearly identical between parsimonious models and full models, both showing good calibration. CONCLUSIONS: Accurate preoperative risk assessment of postoperative mortality, overall morbidity, and 6 complication clusters in a broad surgical population can be achieved with as few as 8 preoperative predictor variables, improving feasibility of routine preoperative risk assessment for surgical patients.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
/
Cirurgia Geral
/
Cuidados Pré-Operatórios
/
Mortalidade Hospitalar
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Ann Surg
Ano de publicação:
2016
Tipo de documento:
Article
País de publicação:
Estados Unidos